For those suffering with acid reflux having, trouble swallowing or even non-cardiac chest pains, Dr. Seth Lipka now offers a skilled technique that can help determine if symptoms are caused by an esophageal motility disorder. Manometry is a procedure that evaluates how the muscles in the esophagus move food from the mouth to the stomach. It also enables doctors to assess the esophageal sphincter—a bundle of muscles at the bottom of the esophagus that keep the contents in the stomach from coming back up. This test helps understand if the esophagus is functioning properly, assists to make a diagnosis, and develop a treatment plan. It can be performed at our Fort Myers office as an outpatient appointment.
For patients suffering with constipation or fecal incontinence, an Anorectal Manometry test may be performed to measure the pressures of the anal sphincter muscles, the sensation in the rectum, and the neural reflexes that are needed for normal bowel movements. There are many causes of fecal incontinence or constipation. If abnormalities are present, they can be treated.
GI motility refers to the movement of food, fluids, and waste through the digestive tract. Manometry is the test to measure this movement in order to properly diagnosis GERD and other gastro conditions.
The swallowing and digestive process
When you swallow, food moves down your esophagus into your stomach in a process called peristalsis. Peristalsis is a wave like motion that we normally are unaware of taking place. Disruptions of these waves may cause chest pain, difficulty swallowing, or pain when swallowing.
The esophageal sphincter is a valve that prevents stomach contents from entering the esophagus. When this muscle is weak the symptoms may present as heartburn or regurgitation of food.
When this muscle does not relax properly, this may be felt as chest pain or food sticking. Esophageal manometry is a test that will detect how well your esophagus moves food down the esophagus, as well as how well the esophageal sphincter will prevent reflux.
What is esophageal manometry?
This is a test used to measure the ability to swallow correctly. This will also measure the muscle that prevents gastric acid from entering the stomach. The results may allow options to treat symptoms such as:
- Difficulty swallowing
- Pain with swallowing
- Chest pain
A small catheter is gently placed into the nose and passed into the stomach after local anesthetic is applied to the nasal passage. The esophageal function will then be evaluated while the patient swallows a small amount of water. The patient should fast for 4 to 6 hours prior to the study. No sedation is required.
After the procedure, it is common to feel some slight discomfort after eating. Frequent distress could be a sign of a disorder.
ESOPHAGEAL MOTILITY DISORDERS
One way to distinguish motility disorders is to look at symptoms of these conditions. The symptoms of a motility disorder range from slight discomfort to acute pain. Some symptoms that can be experienced:
- Difficulty swallowing
- Heartburn that often leads to acid reflux
- Chest pressure that sometimes becomes painful (non-cardiac)
- Frequent coughing
- Previous history of diabetes or immune diseases
What are some commonly detected esophageal disorders and treatments?
Achalasia (an uncommon swallowing disorder)
This is a disorder of the esophagus where normal muscle contractions do not occur and the ability of the lower esophageal sphincter to relax do not occur. As a result, the feeling of food sticking, chest pain, or regurgitation may occur.
GERD: Gastroesophageal reflux disease (delayed gastric emptying)
GERD is diagnosed when acid reflux occurs more than twice a week or causes inflammation in the esophagus. Long-term damage of the esophagus can lead to cancer. Pain from GERD may or may not be relieved with antacids or other over-the-counter (OTC) medication.
Dysphagia (difficulty swallowing)
This is when food and liquids have trouble moving into the stomach.
Functional Esophagogastric outlet obstruction
This a disorder like achalasia where the lower esophageal sphincter does not relax, but the individual still possesses the ability to swallow. This may be treated depending on the severity with recommended procedures
Diffuse esophageal spasm (irregular contractions of esophagus)
This is a disorder where the esophagus contracts simultaneously and may be felt as severe chest pain or food sticking. This may be treated with medications. In patients who fail to respond to initial therapy medications, Botox injections may be used.
Weak esophageal pump
This is a disorder where the ability of the esophagus to contract is weak. Treatments include dietary modifications or a medication such as Bethanecol may be used.
ESOPHAGEAL MANOMETRY AND PH TEST
The test may also be used prior to surgery if you are being considered for anti-reflux surgery or some hernia repairs. Once you and your provider have discussed proceeding with the test, you will receive specific instructions that may include:
What should I do to prepare?
Tell the provider and staff if you have a lung or heart condition, or have any allergies.
Medications: Do not stop taking any medications without first talking to your prescribing doctor.
24 hours prior:
Stop taking calcium channel blockers such as Calan®, Isoptin® (verapamil); Adalat®, Pro-cardia® (nifedipine); and Cardizem®(diltiazem). Also stop taking nitrate and nitroglycerin products such as Isordil® (isosorbide); Nitrobid®, Nitrodisc®, Nitrodur®, Nitrogard®, Transderm-Nitro®, and Tridil®
12 hours prior:
Do not take sedatives such as Xanax® (alprazolam) or Valium® (diazepam)
Day of test
Do not eat or drink anything 4 to 6 hours before the test
The study should take about 10 minutes to perform.
To ensure comfort the nose and throat will be numbed and coated with a spray or gel. During this time you will still be able to breath, swallow, and talk.
A small, flexible tube is passed through your nose down through your esophagus into your stomach.
You may feel some discomfort as the tube is passed, but it takes only about a minute to place the tube. Most people adjust quickly to the tube’s presence. Vomiting and coughing are possible but rarely occur.
During the test you will be asked to take deep breaths and swallow a number of times. The results of the swallows are detected by the catheter and sent to a recording device for interpretation.
After the test
- You may resume your normal diet and activities.
- Any medications that were withheld prior may be resumed.
- You may feel a temporary soreness in your throat. Gargling salt water or lozenges may be helpful.
- If you experience any unusual or severe symptoms call the doctor.